Personalized HIV Care Across Disease Heterogeneity and the Sexually Transmitted Infection Ecosystem

Human immunodeficiency virus (HIV) disease varies across viral populations, host responses, tissues, clinical trajectories and care contexts. Acquisition and intervention outcomes emerge from interactions among biology, health literacy, behavior, exposure networks and health systems. This critical narrative review examines personalization across prevention, lifelong treatment and cure research within the sexually transmitted infection (STI) ecosystem. Established applications include exposure-appropriate prophylaxis, resistance-informed antiretroviral selection, HLA-B*57:01 screening, comorbidity care and adapted services. Sex work, gender diversity, sexual practices and injection drug use define overlapping contexts requiring individual assessment. Coinfections and microbial communities introduce biological interactions; screening, vaccination, partner services and antimicrobial stewardship connect individual care with population effects. Long-acting products broaden choice while increasing reliance on reliable delivery and testing. Cure research adds antibody susceptibility, reservoir dimension and composition and host immunity, but associations and delayed rebound do not establish clinical utility or intervention-free cure. We propose repeated assessment linking actionable heterogeneity and personal goals to clinical and service adaptations. Validation should distinguish baseline risk from treatment-effect modification and evaluate benefit, burden, ecological consequences and equity.